Hybrid Registered Nurse; RN Care Manager - Brooklyn

Hybrid Registered Nurse (RN) Care Manager - Brooklyn

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Brooklyn, NY

Full time

Posted 4 Days Ago

R11935

The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the member's health needs while promoting quality cost effective outcomes.

• Ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status.
• Authorizes covered services and coordinates care regardless of payer.
• Collaborates and communicates with member/family/caregivers, primary care practitioners, and the interdisciplinary team.
• Works with member/family to maintain the most independent living situation possible.
• Assesses, plans and provides continuous care management across all venues of care, including hospital, sub‑acute, long‑term and home settings.
• Regularly assesses members for ongoing eligibility for services based on the specific plan’s eligibility criteria.
• Performs home visits as required to assess members’ living situation, cultural influences, functional and cognitive needs.
• Collaborates with the primary care physician and Inter‑Disciplinary Team (IDT) to develop the Patient Centered Service Plan for the member.
• Ensures appropriate, safe plan for members’ discharge from their plan.
• Identifies same day grievances, investigates and documents accordingly. Documents any grievance according to plan policy.
• Identifies and presents members with complex care management needs or in difficult to manage situations at Intensive Care management meetings (ICM).
• Responds to members’ requests in the designated time frames and completes Initial Adverse Determinations (IAD) as indicated.
• Identifies members requiring Care Management Review (CMR), evaluates documentation provided by the IDT including hospital or nursing home discharge planners, and formulates appropriate plan of care.
• Documents care management/coordination according to company policy to the specific plan the member is enrolled in, which may include monthly telephonic and in-person recertification notes.
• Develops efficient plans of care, authorizing only needed services at the most appropriate levels, utilizing network providers and ensuring that services are based on members’ needs.
• Perform any other job related duties as requested.

• Associates degree in Nursing from an accredited nursing program required.
• Bachelor's degree in Nursing preferred.
• Three (3) years of experience as a registered nurse required.
• Clinical experience in geriatrics and/or managed long‑term care experience preferred.
• Experience using multiple languages may be required based on operational needs.

• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel.
• Ability to communicate effectively with a diverse group of individuals.
• Ability to multi-task and work independently within a team environment.
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices.
• Adhere to code of ethics that aligns with professional practice.
• Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice.
• Strong advocate for members at all levels of care.
• Strong understanding and sensitivity of all cultures and demographic diversity.
• Ability to interpret and implement current research findings.
• Awareness of community & state support resources.
• Critical listening and thinking skills.
• Decision making and problem‑solving skills.
• Strong organizational and time management skills.
• Bilingual speaking and writing skills are preferred.

• Current, unrestricted Registered Nurse licensure in the state of New York required.
• Case Management Certification preferred.

• General office environment; may be required to sit or stand for extended periods of time.
• Up to 25% (regular) travel may be required to travel to different locations, including homes, offices, or other public settings, to perform work duties.